Hand, Foot And Mouth Disease

History

Fact

Explanation

Vesicular erruptions on hands, feet, buttocks, genitalia and mouth

This is a viral illness with vesicular eruptions in mouth, hands, foot, buttocks and genitalia. Infection is caused by coxsackievirus A5, A7, A9, A10, B2, B5 strains, polio virus, echovirus and enterovirus 71 (EV-71). Commonly seen in infants and in children less than 5 years but some adults can also get affected. [1,3]

Fever

Usually fever is the first clinical manifestation. Fever is accompanied by malaise and poor appetite. [1,2]

Sore throat and oral ulcers

Soreness in the throat or mouth is common. Later blisters appear in the oral mucosa and they rupture making ulcers. [1,2]

Skin rash

Flat or raised red spots and blisters usually involves the palms and soles. Skin over the knees, elbows and genitalia can also get affected. [1,2]

Vomiting

Vomiting is common in EV-71 infection. EV 71 can cause disease outbreaks. [1]

Symptoms of dehydration

Affected children can get dehydrated due to vomiting, and poor oral intake because of the sore throat and oral ulcers.[1]

Symptoms of meningitis

Aseptic meningitis is a rare complication of the disease. Headache, neck pain and stiffness and photophobia are the usual symptoms. [1,5]

Symptoms of encephalitis

This is an even rare complication of the disease. Affected children have fever, headache, altered consciousness or drowsiness and seizures. [1,3,5]

Symptoms of myocarditis

Myocarditis is also another rare but life threatening complication of the disease. [3] Although most of the patients are asymptomatic, some have chest pain, palpitations due to arrhythmia and even sudden death. [4]

Involvement of the central nervous system

Except from meningitis and encephalitis, hand- foot and mouth disease can result in Guillain-Barré syndrome, acute cerebellar ataxia and acute transverse myelitis. [5]

References

Hand, Foot, and Mouth Disease (HFMD). Centers for Disease Control and Prevention. [online] [viewed 19 May 2014] Available from: http://www.cdc.gov/hand-foot-mouth/about/index.html

Investigations - for Diagnosis

Fact

Explanation

Detection of the virus

Respiratory tract secretions and stool samples can be collected for viral studies and demonstration of the presence of the virus. [1] Polymerase chain reaction can be used to isolate the virus. [2] However investigations are not necessary as this is a clinical diagnosis.

References

Hand, Foot, and Mouth Disease (HFMD). Centers for Disease Control and Prevention. [online] [viewed 19 May 2014] Available from: http://www.cdc.gov/hand-foot-mouth/about/index.html

Management - General Measures

Fact

Explanation

Health education

The disease is transmitted through infected person's respiratory secretions, blister fluid and feces. Maintenance of good personal hygiene (hand washing, use of handkerchief ) will prevent the disease transmission. Parents are advised to clean their children's toys with disinfectants. [1]

Maintain adequate hydration

Children with dehydration should be given fluids either orally or intravenously. [1]

Antipyeritics

Fever should be treated with antipyretics other than non-steroidal anti inflammatory drugs. [1]

Analgesics

Pain in the mouth can be relieved by analgesics. [1]

References

Hand, Foot, and Mouth Disease (HFMD). Centers for Disease Control and Prevention. [online] [viewed 19 May 2014] Available from: http://www.cdc.gov/hand-foot-mouth/about/index.html

Management - Specific Treatments

Fact

Explanation

Conservative management

Hand, foot and mouth disease is often self-limiting and does not require any treatment. Antipyretics and analgesics can be prescribed for the comfort of the patient. [1,2]